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Oregon State University Chemical Exposure Disaster Questionnaire

Publicly Available, No Cost
The Oregon State University Superfund Research Program and the Pacific Northwest Center for Translational Environmental Health are focused on chemical exposures before, during and after disasters. The Centers developed a broad Disaster Protocol, enabling rapid responses to disasters. In the case of Hurricane Harvey, using the pre-positioned protocol, researchers were able to obtain project-specific human subjects ethical approval and initiate data collection within three weeks of Harvey making landfall in Houston. The questionnaire includes virtual consent and assent, consent to receive individual results from the study, and evaluates informed consent via questions gauging comprehension of study activities and types of data being collected. Modules included in the survey: i) Demographics; ii) Exposure History specific to flooding; iii) Environmental Health; iv) Occupational History, using elements sourced from the Disaster Response Research (DR2) platform. Oregon State University Chemical Exposure Disaster Study Protocol Data Dictionary: Assent statement template: Chemical Exposure Consent Template: The associated protocol can be found:
ACE Toolkit. General Survey Module G: Emergency Response. Question 22 Question 23b Question 23c Adapted from the NIOSH Deepwater Horizon Roster Form, Gulf Coast Oil Spill Initial Survey. (Page 117) Question 23 Question 48-50 Community Assessment for Public Health Emergency Response (CASPER): Appendix B: Question Bank Question 24a-d Question 31-32 Question 35 Question 37 ATSDR Exposure Form: Question 45-46 WTC Health Registry Hurricane Sandy Survey Question 24e-f Question 25-30 Question 33-34 Adapted Question 36a-c o Question 42 o Question 44 o Question 49 o Question 51 o Adapted Question 53

Additional Descriptors

  • In-Person Interview, Online or Mobile App
    • 1-15
      • English
        • 51-74
        • Survey/Questionnaire
          • Age
            • Age: Adult, Child
              • Children: Adolescent or Teen
          • Chemical, Contamination or Release Event
            • Chemical Agent

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